“First do no harm” revisited

Clinicians of every ilk enjoy aphorisms. Favourites include “time is brain” and “common things are common.”

Yet, surely no medical saying is better known than “first do no harm” or, to use the Latin phrase, “primum non nocere.” PubMed shows that there are currently 393 articles with “do no harm” in the title.

Contrary to popular belief the phrase does not appear in the Hippocratic Oath or the Hippocratic corpus (Hippocrates wrote in Greek, not Latin). Rather the saying is attributed to Thomas Inman, as recently as 1860.1 That same year Oliver Wendell Holmes Senior famously remarked in a lecture to the Massachusetts Medical Society, “If the whole material medica, as now used, could be sunk to the bottom of the sea, it would be all the better for mankind—and all the worse for the fishes.’2 He observed that the injuries caused by overmedication were often masked by the disease.

“First do no harm” remains an important injunction against overtreatment. Yet, like many axioms …